Provider Demographics
NPI:1578895892
Name:ADVANCE MEDICAL ACCPTANCE
Entity Type:Organization
Organization Name:ADVANCE MEDICAL ACCPTANCE
Other - Org Name:MEDILINE MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-432-9400
Mailing Address - Street 1:6550 MAPLERIDGE ST STE 214
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4647
Mailing Address - Country:US
Mailing Address - Phone:713-432-9400
Mailing Address - Fax:713-432-9401
Practice Address - Street 1:6550 MAPLERIDGE ST
Practice Address - Street 2:SUITE 214
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4647
Practice Address - Country:US
Practice Address - Phone:713-432-9400
Practice Address - Fax:713-432-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Multi-Specialty
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public HealthGroup - Multi-Specialty